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Open research questions in Cultural Competency in Health Care

98 unresolved questions extracted from the limitations and future-work sections of 1,980 Cultural Competency in Health Care papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • The Indonesian version of FertiSTAT may first be pilot- tested on a small sample representing diverse characteris- tics of women of reproductive age in Indonesia to ensure that its application aligns with the local context. Fol- lowing this preliminary evaluation, broader implemen- tation may be employed in population-based research or clinical services. The use of this instrument may also be accompanied by brief explanations to respondents regarding items that involve sensitive or medical con- cepts in order to minimize potential misunderstanding bias. Future research may explore behavioral changes following completion of the FertiSTAT questionnaire or evaluate its acceptability when applied in primary health- care settings. In primary care, the Indonesian version of FertiSTAT may be used as an initial screening tool to help iden- tify women who have fertility-related risk factors and may benefit from earlier counseling or referral. In fertil- ity counseling workflows, the instrument may function as a structured pre-consultation aid, allowing clinicians to obtain relevant reproductive, lifestyle, and medical history in a more systematic manner before a detailed consultation. In addition, the questionnaire has poten- tial for integration into digital health platforms, such as online reproductive health education tools, patient por- tals, or mobile-based self-assessment systems, which may improve access to fertility awareness information and support earlier health-seeking behavior. In addition, the implementation of the Indonesian ver- sion of FertiSTAT may be expanded beyond clinical and research settings to support public health promotion strategies. It is recommended that this instrument be incorporated into fertility awareness campaigns as part of structured health education efforts aimed at improv- ing knowledge of fertility risk factors, optimal reproduc- tive age, and lifestyle influences. Such integration may facilitate earlier health-seeking behavior and encourage more informed reproductive decision-making. At the policy level, stakeholders may consider embedding fertil- ity awareness components within national reproductive health programs to strengthen reproductive health liter- acy, particularly in the Indonesian context. Hestiantoro et al. Middle East Fertility Society Journal (2026) 31:62 Conclusion The Indonesian version of the FertiSTAT questionnaire has been successfully adapted through a structured transcultural process, demonstrating good content and face validity, as well as evidence of test–retest reliability across several items. However, given the methodological limitations of this study, including the use of non-prob- ability sampling and the absence of certain psychomet- ric evaluations, these findings should be interpreted as preliminary. The study results demonstrate that the instrument has excellent content validity, with the Content Validity Index (CVI) for all items exceeding the recommended thresh- old. In addition, evaluation by the lay panel indicated good face validity, as all items were considered clear, easy to understand, and appropriate within the cultural con- text of the respondents. Test–retest reliability analysis showed that some items demonstrated satisfactory consistency. Variations in reli- ability observed in items that were mainly influenced by the sensitive or subjective nature of the questions, the possibility of natural changes over time, and the extreme homogeneity of responses for certain items. So the result should also be interpreted as preliminary. This study provides initial evidence supporting the applicability of the instrument as a screening tool for identifying fertility risk factors among women of repro- ductive age in Indonesia. Further studies involving larger and more diverse populations, may be needed to strengthen the overall psychometric evaluation and con- firm its broader applicability in clinical and public health settings.

    Transcultural adaptation, validity and reliability testing of infertility risk self-assessment questionnaire (FertiSTAT) to Indonesian language a methodological study · 2026 · DOI

  • Previous research has reported inconsistent findings regarding age, with some studies showing no association and others reporting differences depending on context [26,7]. These inconsistent results suggest that progression through the curriculum alone does not necessarily appear to be associated with reduced negative attitudes, and that structured and continuous integration of intercultural content may be worth exploring in future curriculum development.

    Xenophobia and intercultural sensitivity among nursing and midwifery students: a cross-sectional study · 2026 · DOI

  • Healthcare organizations should provide leadership training programs to improve nurse managers’ decision-making, communication, cultural awareness, and conflict resolution skills. Nurse managers are encouraged to apply culturally sensitive and inclusive leadership practices in their daily work. Nursing educators should include multicultural leadership topics in nursing education programs to prepare future leaders. Future studies should involve larger samples and different healthcare settings to further improve leadership practices in multicultural teams. ACKNOWLEDGMENTS I would like to express my sincere gratitude to my research adviser, Dr. Joel John Dela Merced, for his guidance, support, and encouragement throughout this study. I am also thankful to St. Bernadette of Lourdes College (SBLC), the study participants, and my colleagues for their support and contributions. Most especially, I thank my husband, Sonrio, for his unwavering love, patience, understanding, and encouragement, which inspired me to complete this research. AI DECLARATION STATEMENT AI-supported tools helped with grammar and structure in creating this article. No AI tools were used to collect, analyze, or interpret data; all authors are credited for their academic contributions. REFERENCES Gaspar, F. (2024). Impact of Nurse Manager’s Attributes on Multi-Cultural Nursing Teams: A Scoping Review. Nursing Reports, 14(3), 1676–1692. https://doi.org/10.3390/nursrep14030125 https://epublications.myeduheart.com/index.php/ijnhha/index E-ISSN: 3116-5974 P-ISSN: 3116-5966 303 Van Bogaert, P., Peremans, L., de Wit, M., Van heusden, D., Franck, E., Timmermans, O., & Havens, D. S. (2021). Nurse managers’ perceptions and experiences regarding staff nurse in Psychology, 6. a qualitative https://doi.org/10.3389/fpsyg.2015.01585 study. Frontiers empowerment: Alodhialah, A. M. (2025). Exploring the influence of organizational culture on evidence-based practice adoption among nurses in tertiary hospitals: a qualitative study. BMC Nursing, 24(1).

    Decision-Making Experiences of Nurse Managers Handling Multicultural Staff in Tertiary Hospitals: A Qualitative Inquiry · 2026 · DOI

  • While this study offers deep insights into the micro- dynamics of nursing teams, several methodological Peppler et al. BMC Nursing (2026) 25:521 Page 22 of 24 limitations warrant consideration: First, the qualitative nature and the sample size of six case studies preclude the formulation of a definitive taxonomy. This inductive classification emerged during the research process rather than being predefined in the initial design. Consequently, the typology must be understood as a heuristic frame- work that maps distinct socio-cultural configurations rather than a fixed, universally applicable model. Fur- thermore, the restriction of the sample to urban and metropolitan areas limits the immediate transferability of the findings to rural or small-town healthcare settings, where organisational resource structures and community demographics may differ significantly. Second, access to the empirical field was structurally mediated through nursing management. This institu- tional gatekeeping may have subtly shaped the sample composition by favouring wards with comparatively stable team dynamics, proactive leadership, or a higher baseline readiness for external scrutiny. To mitigate this potential selection bias, we emphasised during the recruitment phase that participation was entirely volun- tary and independent of managerial approval. Empiri- cally, the fact that our final sample successfully captured highly conflicted and fragmented team environments (the Friction-based Teams) demonstrates that manage- ment gatekeeping did not result in a sanitised or overly optimistic selection of cases. Third, because all focus groups were conducted in German, a subtle language-related participation bias cannot be entirely ruled out. International nurses with lower linguistic confidence might have felt restrained from contributing nuanced arguments in a group set- ting. We actively sought to mitigate this barrier by adapt- ing our moderation style to plain German and fostering a supportive environment that encouraged spontaneous peer-translation among colleagues. However, because we did not conduct subsequent transcript validation (mem- ber checking) with individual participants, the extent to which highly subtle or non-verbal meanings could be ver- ified ex post remains limited. Fourth, the positionality of the two field research- ers – as members of the white majority society and as external academics – introduces potential interpretive blind spots. This structural power asymmetry may have influenced data generation, particularly by shaping how openly or defensively experiences of everyday discrimi- nation, xenophobia, or professional devaluation were articulated by international staff. To structurally counter these biases, we implemented a multi-layered reflexivity strategy: preliminary data and raw transcripts were con- tinuously subjected to analysis within multi-disciplinary interpretation groups, and we held participatory vali- dation workshops where our case interpretations were presented to frontline practitioners for critical feedback and correction.

    Reconstructing a typology of approaches to navigating diversity: a comparative qualitative study of German nursing teams · 2026 · DOI

  • language B.T. Kim Tuyen et al. / Vietnam Journal of Community Medicine, Vol. 67, English version No. 1, 2026, 27-30 Table 4.

    WILLINGNESS TO WORK ABROAD AMONG NURSING STUDENTS AT TRA VINH UNIVERSITY IN 2024 · 2026 · DOI

  • A key strength of this study lies in its focus on educa- tors’ lived experiences of Indigenous-specific antiracist education. By centering voices working within systems shaped by racism and colonialism, the study offers insight into both the challenges and possibilities of this work, including its emotional and professional demands and the importance of supportive institutional conditions. The collaborative composition of the research team, which included Indigenous and settler scholars, further strengthens the credibility and depth of the analysis. Several limitations warrant consideration. The posi- tionality of the lead researcher as a white settler may have shaped aspects of interpretation despite ongoing reflex- ive and collaborative processes, underscoring the per- sistence of power dynamics even when efforts are made to foreground Indigenous perspectives. In addition, our decision not to disaggregate Indigenous participants’ experiences—necessary to protect confidentiality within a small community of practice—restricted our ability to examine differences across positionalities. Future stud- ies with larger samples could explore these distinctions more fully and consider their implications for educator support. The study prioritized educators’ learning journeys rather than providing a systematic analysis of pedagogi- cal strategies, curriculum design, or student outcomes. Although participants referenced teaching approaches, further research could more directly investigate peda- gogical practices and their impacts on learners. Similarly, while Indigenous epistemologies informed our frame- work, future scholarship could deepen this grounding by drawing more extensively on Indigenous theoretical traditions and Critical Race Theory. Finally, although participants described institutional barriers, institutions themselves were not the primary object of analysis; sub- sequent research could examine organizational struc- tures, policies, and cultures to better understand both obstacles and conditions that support transformative change.

    Being an Indigenous-specific antiracist educator in health professions: a qualitative study of health educators’ learning journeys in Canada · 2026 · DOI

  • It is important to acknowledge that this critical review does not claim to provide a comprehensive account of the Overall, the integration of intersectional perspectives into qualification frameworks, both in the training of nursing students and in fostering professional-ethical reflection on power relations, emerges as a meaningful and necessary step.

    Nursing education in conflict: How intersectionality impacts access to educational opportunities? · 2026 · DOI

  • Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty.

    Training in Cultural Competence for Mental Health Care: A Mixed-Methods Study of Students, Faculty, and Practitioners from India and USA · 2024 · DOI

  • Objectives: Despite decades of literature recognizing racial disparities (RDs) in emergency medicine (EM), published curricula dedicated to addressing them are sparse.

    Racial disparities in emergency medicine: Implementation of a novel educational module in the emergency medicine clerkship · 2023 · DOI

  • Despite societal, financial and wellbeing costs related to discrimination, and increasing literature on improving diversity, equity and inclusion (DEI), sustainable movements towards addressing health professional education (HPE) system inequities remain elusive.

    Making the invisible visible: How cultural hegemony and uncertainty help us understand health professional education inequities · 2023 · DOI

  • Little is known about the influence of COIL on intercultural sensitivity, a key competency for nursing students to better serve increasingly diverse patient populations.

    The Impact of Collaborative Online International Learning on Intercultural Sensitivity Among Nursing Students in the United States and Japan · 2022 · DOI

  • Scientific literature is rich in publications on the topic, however, the latter problem and its specificity has been insufficiently studied in health care organisations whose performance is especially important for each patient and the cost of errors, possibly caused also by insufficient intercultural competences, may be very great.

    Assessment of Staff Intercultural Competences in Health Care Organisations · 2017 · DOI

  • Since language proficiency is a key requirement of Canadian nursing regulatory bodies, previously unrecognized barriers such as attitudes and beliefs about required English language and nursing communication competency which may hinder their ability to meet local practice standards need to be explored.

    Internationally educated nurses’ reflections on nursing communication in Canada · 2016 · DOI

  • PRACTICE IMPLICATIONS: Recommendations for practice are to: develop transcultural nursing education; promote an ethos of providing culturally competent and culturally safe nursing to people of another culture; improve resources available to nurses; provide easier access to formal interpreter services with continuity of interpreters for patients and conduct further research into aspects of health care in multicultural Ireland.

    Educational needs of nurses when nursing people of a different culture in Ireland · 2008 · DOI

  • Although a body of knowledge is growing regarding factors that foster academic success of undergraduate nursing students of color, there is limited information about Hispanic students in general, and Mexican American students in particular in BSN programs.

    Fostering Academic Success of Mexican Americans in a BSN Program: An Educational Imperative · 2006 · DOI

  • To ensure that cultural minority groups are not misrepresented by standardized measures, social workers--as effective patient advocates--must be familiar with the underlying conceptual assumptions of measurement theory to articulate the strengths and limitations of measures used to investigate populations with which they have not been tested and advocate for cultural minority groups using language and terminology that measurement practitioners can understand and embrace.

    Assessment and the Ubiquity of Culture: Threats to Validity in Measures of Health-Related Quality of Life · 2005 · DOI

  • Results indicated that specific cultural sensitivity and competence training components are lacking in most programs, a variety of under represented groups are studied, and hands-on community-based educational experiences receive little attention.

    Cultural Competence Development in University Health Education Courses · 1996 · DOI

  • However, limited research has simultaneously examined the relationship between cultural intelligence, communication skills, and social interactions among emergency department personnel.

    Relationship between Cultural Intelligence with Communication Skills and Social Interactions of Emergency Department Staff: A Cross-Sectional StudyRelationship between Cultural Intelligence with Communication Skills and Social Interactions of Emergency Department Staff: A Cross-Sectional StudyRelationship between Cultural Intelligence with Communication Skills and Social Interactions of Emergency Department Staff: A Cross-Sectional Study · 2026 · DOI

  • Few studies have evaluated interactive theater-based interventions for collective healing from racial trauma and for addressing cultural dilemmas, situations in which individuals navigate internalized stigma, interpersonal bias, and systemic exclusion within professional settings.

    Theater-Based Program for Collective Healing Among Asian American Health Care Professionals · 2026 · DOI

  • 1 Toward empirical validation and quantifiable pathways The most important limitation of the study is that the model has not yet been tested empirically.

    Bridging the epistemic gap: a psychological acceptance model for the cross-cultural health communication of traditional Chinese medicine · 2026 · DOI

  • While the effects of culture in cognition, emotion, behavior, and health are not disputed, the casual relationships between them and their specific mechanisms are still not clearly understood.

    Social determinants of health in biocultural research: a review of evidence · 2025 · DOI

  • Lastly, conflicting results are seen for its effects on cultural competence, due to differences in the measurement instruments and cultural academic assignments complementary to reflective writing.

    A systematic review of reflective writing in the pharmacy curriculum: Impact on patient-centred communication skills or cultural competence · 2022 · DOI

  • Purpose Despite the fact that shame is recognized as a significant factor in clinical encounters, it is under-recognized, under-researched and under-theorized in health prevention, assessment and cross-cultural contexts.

    Cultural adaptation and validation of the Others as Shamer scale: a barrier to effective health-care assessment · 2022 · DOI

  • OBJECTIVES: Older immigrants of Latin American descent are disproportionately impacted by dementia, yet little is known about their dementia- and brain health-related knowledge.

    Perceptions of and Knowledge Acquisition about Brain Health and Aging among Latin American Immigrants:A QualitativePaper · 2022 · DOI

  • However, little is known as to the success of cultural competence educational interventions in undergraduate nursing curricula and there remains a lack of consensus within the literature as to how it should be structured, organised and facilitated.

    Intercultural readiness of nursing students: An integrative review of evidence examining cultural competence educational interventions · 2021 · DOI

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